December 3rd, 2010 by BobDoherty in Better Health Network, Health Policy, News, Opinion
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In assessing the “best and worst” of the recommendations from the National Commission on Fiscal Responsibility, Washington Post blogger Ezra Klein accuses the Commission of “cowardice” in addressing healthcare spending:
“The plan’s healthcare savings largely consist of hoping the cost controls . . . and various demonstration projects in the new healthcare law work and expanding their power and reach. . . In the event that more savings are needed, they throw out a grab bag of liberal and conservative policies . . . but don’t really put their weight behind any. . .[their] decision to hide from the big questions here is quite disappointing . . . ”
Pretty harsh words, considering that in other respects Klein gives the Commission high marks. But I think there is a lot more to the Commission’s recommendations on healthcare spending than meet’s (Klein’s) eyes, even though I have my own doubts about the advisability and political acceptability of many of them. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
November 22nd, 2010 by BobDoherty in Better Health Network, Health Policy, News, Opinion
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Senator Scott Brown (R-MA) thinks so. So does Senator Ron Wyden (D-OR). And Senator Bernie Sanders (I-VT). Senators Brown, Wyden and Sanders have introduced the “Empowering States to Innovate Act.” Ezra Klein blogs that the Senators may have found a way forward on health reform.
“If a state can think of a plan that covers as many people, with as comprehensive insurance, at as low a cost, without adding to the deficit, the state can get the money the federal government would’ve given it for health-care reform but be freed from the individual mandate, the exchanges, the insurance requirements, the subsidy scheme and pretty much everything else in the bill,” Ezra Klein writes. “If conservative solutions are more efficient, that will be clear when their beneficiaries save money. If liberal ideas really work better, it’s time we found out. Forget repeal and replace, or even reform and replace. How about compete and succeed?”
The Wonk Room reports that Wyden, Brown, Sanders, who co-sponsored the original innovative waivers amendment, believe that their home states of Oregon, Massachusetts, and Vermont are leading the pack in adopting innovative approaches. These include the well-known Massachusetts program that Brown voted for as a state legislator, and single payer bills that have been introduced in Vermont and Oregon. The bill, though, also could appeal to states seeking a more conservative, less regulatory solution, since they would be able to decide how they wanted to provide comprehensive coverage to the uninsured, free of most of the mandates of the Affordable Care Act (ACA). Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
November 8th, 2010 by BobDoherty in Better Health Network, Health Policy, News, Opinion
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My image of Pittsburgh has been one of a blue-collar, rough-and-tumble town: Perogies, Heinz ketchup, steelworkers, football, and Roberto Clemente. But an exhibit in Pittsburgh’s airport the other day informed me that Pittsburgh also is the home of the iconic “Mr. Roger’s Neighborhood” — the gentle PBS show that entertained toddlers for generations. Mr. Rogers always started the show off with the following verse:
It’s a beautiful day in this neighborhood,
A beautiful day for a neighbor,
Would you be mine?
Could you be mine?
It’s a neighborly day in this beautywood,
A neighborly day for a beauty,
Would you be mine?
Could you be mine?
I have always wanted to have a neighbor just like you,
I’ve always wanted to live in a neighborhood with you.
So let’s make the most of this beautiful day,
Since we’re together, we might as well say,
Would you be mine?
Could you be mine?
Won’t you be my neighbor?
Won’t you please,
Won’t you please,
Please won’t you be my neighbor?
Fittingly, the same week that I was reminded of “Mr. Roger’s Neighborhood,” the American College of Physicians (ACP) released its “medical home neighborhood” position paper. The paper was developed by a workgroup of ACP’s Council of Subspecialty Societies (CSS), which is comprised of representatives of internal medicine subspecialty societies and related organizations.
Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
October 24th, 2010 by BobDoherty in Better Health Network, Health Policy, News, Opinion, Research
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Last month the U.S. Census Bureau released its annual survey on health insurance coverage. The results were startling, yet few politicians seemed to take notice:
— The number of people with health insurance declined for the first time ever in almost two decades. In fact, as reported by CNN this is the first time since the Census Bureau started collecting data on health insurance coverage in 1987 that fewer people reported that they had health insurance: “There were 253.6 million people with health insurance in 2009, the latest data available, down from 255.1 million a year earlier.” The percentage of the population without coverage increased from 15.4 percent to 16.7 percent.
— Almost 51 million U.S. residents had no health insurance coverage at all, a record high, and an increase of almost five million uninsured from 2008.
— Fewer Americans received health insurance coverage through their jobs, continuing a decade-long trend. The number covered by employment-based health insurance declined from 176.3 million to 169.7 million, reports the Census Bureau. Based on the Census numbers, the Economic Policy Institute observes that “the share of non-elderly Americans with employer-sponsored health insurance declined for the ninth year in a row, down from 61.9% in 2008 to 58.9% in 2009, a total decline of 9.4 percentage points since 2000.” Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
October 18th, 2010 by BobDoherty in Better Health Network, Health Policy, News, Opinion, Research
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From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be “reasonable and necessary,” Medicare establishes a payment rate that takes into account complexity and other “inputs” that go into delivering the service. But it is prohibited by law from varying payments based on how well an intervention works.
This would change under a “dynamic pricing” approach proposed by two experts in this month’s issue of Health Affairs. The article itself is available only to Health Affairs subscribers, but the Wall Street Journal health blog has a good summary.
The researchers propose that Medicare pay more for therapies with “superior” results and the same for two therapies with comparable effectiveness. A new service without any evidence on its relative effectiveness would be reimbursed in the usual way for the first three years, during which research would be conducted on its comparative effectiveness. If such research found that the service was less effective than other interventions, Medicare would have the authority to reduce payments. If it was found to be more effective, Medicare could pay more than for other available interventions. The WSJ blog gives an example of how this would work. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
